Gynecological Health: What You Need to Know

Have you ever played the telephone game? You sit in a circle and whisper something in the ear of the person next to you. The process repeats until the last person in the circle says the phrase aloud to the group.

More often than not, the phrase that the last person utters is far from the original comment.

Similarly, myths and misunderstandings about gynecologic health tend to get passed along from person to person until we believe them.

Navya Nair, M.D., M.P.H., wants to set the record straight. Dr. Nair is a researcher at Sylvester Comprehensive Cancer Center and is a gynecologic oncologist for the University of Miami Health System.

Bleeding after menopause

First and foremost, Dr. Nair stresses that there must be no confusion about bleeding after menopause. “Menopause is defined as one year of having no periods. Any bleeding after menopause is abnormal and needs to be evaluated.” That includes spotting or bleeding just one time. Dr. Nair says patients should see a provider if they experience this kind of bleeding.

HPV: Everyone is exposed

“All of us get exposed to human papillomavirus (HPV) at some point in our lives; for some people, it persists,” she says. When that happens, the virus can develop into cervical precancer and, subsequently, cancer. Though less common, the virus can also cause anal, vulvar, and oropharyngeal cancers.

“The HPV vaccine is effective at preventing cervical cancers. Imagine a vaccine that can prevent cancer. This vaccine also decreases persistent HPV infection, which is the big risk factor for anal, vulvar, and oropharyngeal cancers,” Dr. Nair says. Oropharyngeal cancers develop in the middle part of the throat.

The best time to get vaccinated against HPV is between the ages of nine and 11, according to Dr. Nair. You can still be vaccinated up to age 45. Everyone, including boys and men, should be vaccinated. The thing Dr. Nair stresses is that the HPV vaccine can prevent and eliminate cervical cancer.

Any discussion of HPV and cervical cancer is an opportunity to dispel the myth that having a history of multiple sexual partners causes cervical cancer. However, if a person has a human immunodeficiency virus (HIV), their body has a harder time fighting off an HPV infection. “For that reason, there is a higher incidence of HPV among people living with HIV,” Dr. Nair says.

The power of Pap tests

The Pap test or Pap smear remains the best screening tool to prevent cervical cancer, so Dr. Nair recommends cervical cancer screening with a Pap test for women between the ages of 21 and 65 who still have a cervix. Pap screening now includes HPV testing for some patients. Cervical cancer screening with a Pap and HPV test can detect precancerous changes that can be treated to prevent the development of cancer. The latest guidelines from the American Cancer Society provide further details.

Black women are diagnosed more often with cervical and uterine cancers than white women. They are also more likely to die from these cancers than white women. “We don’t know why, but for this reason, it is especially important for Black women to get screened,” Dr. Nair says.

Hysterectomy and gynecological cancer risk

Unfortunately, a hysterectomy does not protect women from all cancers of the reproductive system.

To understand why, Dr. Nair says knowing what the surgery involves is important. “A subtotal or supracervical hysterectomy removes the uterus, but not the cervix. A total hysterectomy removes the uterus and cervix. A salpingo-oophorectomy removes the fallopian tubes and ovaries; this is sometimes done at the same time as a hysterectomy. However, in either case, after a hysterectomy, a woman may still have her fallopian tubes, ovaries, vulva and vagina, and can still develop any of those gynecological cancers.”

That’s why, even after menopause or a hysterectomy, a yearly gynecological exam is important.

The “silent killer” does send signals

Despite how much we hear ovarian cancer called a “silent killer,” it usually has symptoms and is not so silent. “The symptoms can be vague or mimic other conditions, so people often don’t recognize it. If you have persistent bloating, nausea, decreased appetite or use the bathroom frequently for a period of more than two weeks, get checked for ovarian cancer. See your doctor and get imaging. And again, bleeding after menopause is not normal; if that happens, see your doctor,” Dr. Nair says.

While some people delay getting screened because they fear getting bad news, the earlier a cancer is diagnosed, the better your chances of survival. “If you are diagnosed with cancer, it’s important to ask about getting treated at an NCI-designated cancer center with access to clinical trials,” Dr. Nair says.

Her biggest takeaway?

“Knowing your body is important. Recognize when something has changed.”

There’s no reason any woman should stay in the dark about gynecological cancers. Separating fact from fiction gives you a road map to better health, no matter your age or family history.

Nancy Moreland is a regular contributor to the UHealth Collective. She has written for several major health care systems and the CDC. Her writing also appears in the Chicago Tribune and U.S. News & World Report.

Tags: cancer prevention, Dr. Navya Nair, gynecologic oncologist, Sylvester Comprehensive Cancer Center